Formulir Pengumpulan Surveilans Infeksi Rumah Sakit

UNIT : Nakula
Bulan/Tahun : Juli 2018

Jumlah hari pemakaian alat

No Nama Ps Register Tgl Masuk Tgl Keluar Lama dirawat
ETT CVL IVL UC
1 Masturoh, Ny. 11124 1/7/2018 9/7/2018 8 8
0 0 0
2 Emih, Ny 24440 1/7/2018 4/7/2018 3 3
0 0 0
3 Sanaah, Ny 24480 2/7/2018 4/7/2018 2 2
0 0 0
4 Masnoto, Tn 24479 2/7/2018 4/7/2018 2 2
0 0 0
5 Ramun, Tn 24482 2/7/2018 6/7/2018 4 4
0 0 0
6 Hana Kariska, Nn 24475 2/7/2018 4/7/2018 2 2
0 0 0
7 Samudi, Tn 24509 2/7/2018 4/7/2018 2 2
0 0 0
8 Suwarto, Tn 16677 2/7/2018 4/7/2018 2 2
0 0 0
9 Abdul Haq, Tn 7792 2/7/2018 5/7/2018 3 3
0 0 0
10 Susanto, Tn 11562 2/7/2018 5/7/2018 3 3
0 0 0
11 Uswatun Khasanah, Ny 24513 2/7/2018 5/7/2018 3 3
0 0 0
12 Suparto Agustinus, Tn 24515 2/7/2018 5/7/2018 3 3
0 0 0
13 Hj. Wasni, Ny 24517 3/7/2018 4/7/2018 2 2
0 0 0
14 Nani Sumarsih,Ny 11517 3/7/2018 10/7/2018 7 7
0 0 0
15 Siti Nur Hermawati, Ny 24561 3/7/2018 5/7/2018 2 2
0 0 0
16 Asiyah, Ny 17120 3/7/2018 6/7/2018 3 3
0 0 0
17 H. Lasa Effendi, Tn 1918 4/7/2018 6/7/2018 2 2
0 0 0
18 M. Zainudin Rahmat, Tn 17247 4/7/2018 6/7/2018 2 2
0 0 0
19 Minah, Ny 24541 4/7/2018 6/7/2018 2 2
0 0 0
20 Nasta, Tn 14671 4/7/2018 8/7/2018 4 4
0 0 0
21 Nengsih, Ny 24620 4/7/2018 7/7/2018 3 3
0 0 0
22 Kati, Ny 24093 5/7/2018 9/7/2018 4 4
0 0 0
23 Dicky Dwi Putranto, Sdr 24666 5/7/2018 6/7/2018 1 1
0 0 0
24 Juju Juleha, nn 24514 5/7/2018 8/7/2018 3 3
0 0 0
25 Yuyun,Ny 24667 5/7/2018 9/7/2018 4 4
0 0 0
26 Surdam, Tn 20085 6/7/2018 8/7/2018 2 2
0 0 0
27 Hj. Wasni, Ny 832 6/7/2018 8/7/2018 2 2
0 0 0
28 Solehudin, Tn 24675 6/7/2018 9/7/2018 3 3
0 0 0
29 Tasmin, Tn 24686 6/7/2018 8/7/2018 2 2
0 0 0
30 Sayudi Ratno, Tn 24669 6/7/2018 07/13/2018 7 7
0 0 2
31 Tasiroh, Tn 24691 6/7/2018 8/7/2018 2 2
0 0 0
32 Pratiwi Anansyah, Nn 24115 7/7/2018 7/7/2018 0 0
0 0 0
33 Suryadi Bin Karsan, Tn 24712 7/7/2018 10/7/2018 3 3
0 0 0
34 Kadi, Tn 24714 7/7/2018 10/7/2018 3 3
0 0 0
35 Ferry Abdul Muin, Sdr 24715 7/7/2018 8/7/2018 1 1
0 0 0
36 Samiun, Tn 24717 7/7/2018 11/7/2018 4 4
0 0 0
37 Kartim, Tn 24718 7/7/2018 10/7/2018 3 3
0 0 0
38 Nenti, Ny 24719 7/7/2018 9/7/2018 2 2
0 0 0
39 Masunah, Ny 24720 7/7/2018 8/7/2018 1 1
0 0 1
40 Nining Yunengsih, Ny 24722 7/7/2018 8/7/2018 1 1
0 0 0
41 Joko Prihantoro Agung,Tn 24725 8/7/2018 8/7/2018 0 0
0 0 0
42 Hani Rachmawati, Nn 24730 8/7/2018 10/7/2018 2 2
0 0 0
43 Surjaya, Tn 24696 8/7/2018 10/7/2018 2 2
0 0 1
44 Tarmin,Tn 24733 8/7/2018 12/7/2018 4 4
0 0 0
45 Waskem, Ny 24734 8/7/2018 11/7/2018 3 3
0 0 0
46 Desy Rahmawati Syah, Ny 24736 8/7/2018 8/7/2018 0 0
0 0 0
47 Sukarih, Ny 24737 8/7/2018 8/7/2018 0 0
0 0 0
48 Tursinih, Ny 24738 8/7/2018 9/7/2018 1 1
0 0 0
49 Sardika, Tn 21373 8/7/2018 10/7/2018 2 2
0 0 0
50 Warsono, Tn 21770 8/7/2018 11/7/2018 3 3
0 0 0
51 Ibun Arif, Tn 24741 8/7/2018 10/7/2018 2 2
0 0 0
52 Saripah, Ny 24744 9/7/2018 10/7/2018 2 2
0 0 0
53 H. Sanusi, Tn 24773 9/7/2018 11/7/2018 2 2
0 0 0
54 Casinih, Ny 24770 9/7/2018 11/7/2018 2 2
0 0 0
55 Sarusa, Tn 24787 9/7/2018 11/7/2018 2 2
0 0 0
56 Caspani, Tn 6963 9/7/2018 10/7/2018 1 1
0 0 0
57 Rasih, Ny 24793 9/7/2018 12/7/2018 3 3
0 0 0
58 Durahman, Tn 24803 10/7/2018 11/7/2018 2 2
0 0 0
59 Islakhiyah, Ny 24802 10/7/2018 12/7/2018 2 2
0 0 0
60 Wastono, Tn 24812 10/7/2018 07/13/2018 3 3
0 0 0
61 Surtini, Ny 24848 10/7/2018 10/7/2018 1 1
0 0 1
62 Aan Mustofa, Tn 24357 10/7/2018 07/13/2018 3 3
0 0 0
63 Rasja, Tn 24847 10/7/2018 07/13/2018 3 3
0 0 0
64 Uun Kurnaesih, Ny 24850 10/7/2018 11/7/2018 1 1
0 0 0
65 Sri Untari, Ny 24853 10/7/2018 12/7/2018 2 2
0 0 0
66 Warta, Tn 24854 10/7/2018 07/13/2018 3 3
0 0 0
67 Sichah, Ny 24855 10/7/2018 07/15/2018 5 5
0 0 0
68 Tri Sulastri, Ny 24856 10/7/2018 07/13/2018 3 3
0 0 0
69 Rudi kharudin, Tn 24892 11/7/2018 07/13/2018 2 2
0 0 0
70 Nursyamsi, Tn 10915 11/7/2018 07/13/2018 2 2
0 0 0
71 Marinah, Ny 24883 11/7/2018 07/13/2018 2 2
0 0 0
72 Ii Nurtiwi, Nn 24923 11/7/2018 07/13/2018 2 2
0 0 0
73 Ajo Sukarjo, Tn 24915 11/7/2018 12/7/2018 1 1
0 0 0
74 Juhaedi,Tn 24924 11/7/2018 07/14/2018 3 3
0 0 0
75 Tarikem,Ny 24925 11/7/2018 07/14/2018 3 3
0 0 0
76 Saodah, Ny 24928 11/7/2018 07/13/2018 2 2
0 0 0
77 Tarmun, Tn 24929 11/7/2018 07/14/2018 3 3
0 0 0
78 Sri Astuti, Ny 24927 11/7/2018 07/14/2018 3 3
0 0 0
79 Rumidi, Tn 24951 12/7/2018 07/13/2018 2 2
0 0 0
80 Kusmawati, Ny 12962 12/7/2018 07/13/2018 2 2
0 0 0
81 Udin Kasnudin, Tn 24976 12/7/2018 07/16/2018 5 5
0 0 0
82 Sieha, Ny 24985 12/7/2018 07/17/2018 5 5
0 0 0
83 Sarman, Tn 24994 12/7/2018 07/14/2018 2 2
0 0 0
84 Rasiman, Tn 25003 13/07/2018 07/13/2018 0 0
0 0 0
85 Warna, Tn 24983 13/07/2018 07/15/2018 2 2
0 0 0
86 Karmi, Ny 25018 13/07/2018 07/15/2018 2 2
0 0 0
87 Masamah Ny 4800 13/07/2018 07/15/2018 2 2
0 0 0
88 Juminah, Ny 15081 13/07/2018 07/14/2018 1 1
0 0 1
89 Cuci Hati, Ny 25010 14/07/2018 17/07/2018 3 3
0 0 0
90 Muh. Sajuri, Tn 25030 14/07/2018 15/07/2018 2 2
0 0 0
91 Eko Budiharto, Tn 25032 14/07/2018 14/07/2018 1 1
0 0 1
92 Fahmi Yusuf, Sdr 25035 14/07/2018 17/07/2018 3 3
0 0 0
93 Hj. Khilyatun, Ny 18672 14/07/2018 16/07/2018 2 2
0 0 0
94 Surati, Ny 25036 14/07/2018 18/07/2018 4 4
0 0 0
95 Wasti, Ny 25041 14/07/2018 18/07/2018 4 4
0 0 0
96 Salim Bin Carta, Tn 4988 15/07/2018 18/07/2018 3 3
0 0 0
97 Casmita Bin Casmad, Tn 25048 15/07/2018 17/07/2018 2 2
0 0 0
98 Rasteni,Ny 13195 15/07/2018 18/07/2018 3 3
0 0 0
99 Wahyudi, Tn 25056 15/07/2018 15/07/2018 1 1
0 0 1
100 Sri Sugiyanti, Ny 25057 15/07/2018 16/07/2018 1 1
0 0 0
101 Moh. Carma, Tn 25060 15/07/2018 19/07/2018 4 4
0 0 0
102 Nasipah, Ny 25061 16/07/2018 17/07/2018 2 2
0 0 0
103 Mustara Bin Waja, Tn 25094 16/07/2018 19/07/2018 3 3
0 0 0
104 Sanawi,Tn 25104 16/07/2018 20/07/2018 4 4
0 0 0
105 Sukirno,Tn 25110 16/07/2018 18/07/2018 2 2
0 0 0
106 Melandri, Nn 25112 16/07/2018 17/07/2018 1 1
0 0 0
107 Jahuri, Tn 25130 17/07/2018 20/07/2018 4 4
0 0 0
108 Sarjana, Tn 25142 17/07/2018 17/07/2018 1 1
0 0 0
109 Tayem, Ny 25137 17/07/2018 19/07/2018 3 3
0 0 0
110 Nino Suratno, Tn 22373 17/07/2018 18/07/2018 2 2
0 0 0
111 Fatmah Satarufa, Ny 25147 17/07/2018 18/07/2018 2 2
0 0 0
112 Istiqomah, Ny 25151 17/07/2018 19/07/2018 2 2
0 0 0
113 Sopiah, Ny 24894 17/07/2018 18/07/2018 2 2
0 0 0
114 Carnoto,Tn 23228 17/07/2018 20/07/2018 3 3
0 0 0
115 Drs. H. Hasan Sukirno, Tn 25154 17/07/2018 19/07/2018 2 2
0 0 0
116 Abdul Rosyid, Tn 25155 17/07/2018 19/07/2018 2 2
0 0 0
117 Fatimah, Ny 25159 17/07/2018 20/07/2018 3 3
0 0 0
118 Abdul Hamid, Tn 23831 18/07/2018 20/07/2018 3 3
0 0 0
119 Karwi,Ny 25192 18/07/2018 20/07/2018 2 2
0 0 0
120 Ayu Fauziyyah, Ny 12722 18/07/2018 19/07/2018 2 2
0 0 0
121 Bravo Siera Lumbantoruan, Sdr 25197 18/07/2018 20/07/2018 2 2
0 0 0
122 Juwita, Ny 25200 18/07/2018 19/07/2018 1 1
0 0 0
123 Aditya Maulana 25217 19/07/2018 21/07/2018 2 2
0 0 0
124 H. Asmuni, Tn 16294 19/07/2018 21/07/2018 2 2
0 0 0
125 Sri Prihandini, Ny 25236 19/07/2018 24/07/2018 5 5
0 0 0
126 A. Sumarsi, Ny 25113 19/07/2018 20/07/2018 1 1
0 0 1
127 Margunah, Tn 25160 19/07/2018 21/07/2018 2 2
0 0 0
128 Nurhayati, Ny 25256 19/07/2018 21/07/2018 2 2
0 0 0
129 Castiwen, Ny 25252 19/07/2018 21/07/2018 2 2
0 0 0
130 Saniah, Ny 4754 20/07/2018 23/07/2018 4 4
0 0 0
131 Kasnoto,Sdr 25266 20/07/2018 21/07/2018 2 2
0 0 0
132 Desri Bt Tasih, Ny 25272 20/07/2018 24/07/2018 5 5
0 0 0
133 Karmi, Ny 25018 20/07/2018 25/07/2018 6 6
0 0 0
134 Sulhaida Naitboho,Nn 25278 20/07/2018 21/07/2018 2 2
0 0 0
135 Hj.Raswi,Tn 25283 20/07/2018 22/07/2018 2 2
0 0 0
136 Effendi Tirta Rahayu,Tn 18060 21/07/2018 22/07/2018 2 2
0 0 0
137 Robby Suwarno, Tn 22993 21/07/2018 22/07/2018 2 2
0 0 0
138 Annisa Nuryamin, Ny 19582 21/07/2018 23/07/2018 3 3
0 0 0
139 Hj. Wartiman,Ny 25289 21/07/2018 23/07/2018 3 3
0 0 0
140 Sartono Tn 9259 21/07/2018 26/07/2018 6 6
0 0 0
141 Saniri Binti Tarim, Ny 25301 21/07/2018 23/07/2018 3 3
0 0 0
142 Ijah Ny 4146 21/07/2018 24/07/2018 3 3
0 0 0
143 Umihani,Ny 13266 21/07/2018 24/07/2018 3 3
0 0 0
144 Ety Rohaeti, Ny 16022 21/07/2018 21/07/2018 0 0
0 0 0
145 Deddy Affandi,Tn 25304 21/07/2018 26/07/2018 5 5
0 0 0
146 Warsika,Tn 25308 21/07/2018 25/07/2018 4 4
0 0 0
147 Caskiwan, Tn 25311 22/07/2018 22/07/2018 1 1
0 0 0
148 Anton, Tn 25317 22/07/2018 23/07/2018 2 2
0 0 0
149 Rupinih, Ny 15428 22/07/2018 25/07/2018 4 4
0 0 0
150 Rasti, Ny 25331 22/07/2018 26/07/2018 4 4
0 0 0
151 Romanah, Ny 25332 22/07/2018 24/07/2018 2 2
0 0 0
152 Abdul Halim, Tn 25336 22/07/2018 25/07/2018 3 3
0 0 0
153 Wartinih,Ny 25339 23/07/2018 24/07/2018 2 2
0 0 0
154 Rudi, Tn 13082 23/07/2018 23/07/2018 1 1
0 0 0
155 Ahmad Kosasih, Tn 25356 23/07/2018 25/07/2018 3 3
0 0 0
156 Ade Irfansah, Tn 25234 23/07/2018 24/07/2018 2 2
0 0 0
157 Masyono Bin Kadisan, Tn 25378 23/07/2018 24/07/2018 1 1
0 0 0
158 Kunawi, Tn 25381 23/07/2018 27/07/2018 4 4
0 0 0
159 Sri Kushendrayanti,Ny 25384 24/07/2018 25/07/2018 2 2
0 0 0
160 Abdul Wahid,Tn 25385 24/07/2018 24/07/2018 1 1
0 0 0
161 Wasem,Ny 25390 24/07/2018 24/07/2018 1 1
0 0 1
162 Antiman, Tn 25309 24/07/2018 27/07/2018 3 3
0 0 1
163 Rochmat Hidayat, Tn 25422 24/07/2018 25/07/2018 1 1
0 0 0
164 Turni, Ny 25423 24/07/2018 26/07/2018 2 2
0 0 0
165 Sumiati, Ny 25425 24/07/2018 27/07/2018 3 3
0 0 0
166 Balkia, Sdr 25426 24/07/2018 26/07/2018 2 2
0 0 0
167 Warinih, Ny 3063 24/07/2018 26/07/2018 2 2
0 0 0
168 Abdurachman, Tn 25427 24/07/2018 25/07/2018 1 1
0 0 0
169 Nilta Lutfiyani, Nn 2657 24/07/2018 26/07/2018 2 2
0 0 0
170 Nursyamsi, Tn 10915 25/07/2018 28/07/2018 3 3
0 0 0
171 Mahfudin, Tn 11898 25/07/2018 27/07/2018 2 2
0 0 0
172 Inayah Rohimi, Ny 25475 25/07/2018 27/07/2018 2 2
0 0 0
173 Wasman, Tn 22967 25/07/2018 27/07/2018 2 2
0 0 0
174 Casminah, Ny 25476 25/07/2018 27/07/2018 2 2
0 0 0
175 Rasinih, Ny 25433 25/07/2018 25/07/2018 1 1
0 0 0
176 Sukawan,Tn 25482 25/07/2018 27/07/2018 2 2
0 0 0
177 Edi Syahputra,Tn 25485 25/07/2018 25/07/2018 0 0
0 0 0
178 Rahayu Budiarti,Ny 25324 25/07/2018 27/07/2018 2 2
0 0 0
179 Subandi, Tn 19345 26/07/2018 30/07/2018 5 5
0 0 0
180 Wartinih,Ny 25339 26/07/2018 28/07/2018 3 3
0 0 0
181 Kartini,Ny 25518 26/07/2018 30/07/2018 5 5
0 0 0
182 Kardana,Tn 25519 26/07/2018 27/07/2018 2 2
0 0 0
183 Minah, Ny 24541 26/07/2018 31/07/2018 5 5
0 0 0
184 Nahdliyah Sholihah Afriyani,Nn 25526 26/07/2018 28/07/2018 2 2
0 0 0
185 Arsiti, Ny 25454 27/07/2018 29/07/2018 3 3
0 0 0
186 Sri Weni Lestari Ny 1730 27/07/2018 28/07/2018 2 2
0 0 0
187 Maslahah, Ny 25534 27/07/2018 28/07/2018 2 2
0 0 0
188 Nuraeni, Ny 25547 27/07/2018 31/07/2018 4 4
0 0 0
189 Tolib,Tn 25550 27/07/2018 27/07/2018 1 1
0 0 1
190 Kasinih,Ny 25543 27/07/2018 29/07/2018 2 2
0 0 0
191 Anisa Maesaroh, Nn 25557 27/07/2018 28/07/2018 1 1
0 0 0
192 Wasni, Ny 25558 28/07/2018 30/07/2018 3 3
0 0 0
193 Akmad, Tn 1859 28/07/2018 29/07/2018 2 2
0 0 0
194 Dasan, Tn 25561 28/07/2018 31/07/2018 4 4
0 0 0
195 Samsudin, Tn 24321 28/07/2018 30/07/2018 2 2
0 0 0
196 Takim, Tn 13057 28/07/2018 29/07/2018 1 1
0 0 0
197 Hj. Taspen 25574 28/07/2018 28/07/2018 1 1
0 0 0
198 Rawitem, Ny 12810 28/07/2018 30/07/2018 2 2
0 0 0
199 Abdurrohman, Tn 7042 29/07/2018 29/07/2018 1 1
0 0 0
200 Dasni Ny 8574 29/07/2018 30/07/2018 2 2
0 0 0
201 Khaerun Nisa, Ny 951 29/07/2018 1/8/2018 4 4
0 0 0
202 Undang Sutarna,Tn 25586 29/07/2018 30/07/2018 1 1
0 0 0
203 Sanita, Tn 25590 29/07/2018 1/8/2018 3 3
0 0 0
204 H. Rawun, Tn 25591 29/07/2018 30/07/2018 1 1
0 0 0
205 Suwarti, Ny 11108 30/07/2018 31/07/2018 2 2
0 0 0
206 Diah Muljaningrum,Ny 25617 30/07/2018 1/8/2018 2 2
0 0 0
207 Jupriyah, Ny 23490 30/07/2018 1/8/2018 2 2
0 0 0
208 Duniyati, Ny 19920 30/07/2018 2/8/2018 3 3
0 0 0
209 Ruhenda, Tn 25625 30/07/2018 1/8/2018 2 2
0 0 0
210 Kenah, Ny 13972 30/07/2018 1/8/2018 2 2
0 0 0
211 Mohamad Suratno,Tn 25632 30/07/2018 1/8/2018 2 2
0 0 0
212 Romanah, Ny 25332 31/07/2018 2/8/2018 3 3
0 0 0
213 Sutinih, Ny 17012 31/07/2018 3/8/2018 4 4
0 0 1
214 Saerih, Tn 25619 31/07/2018 2/8/2018 2 2
0 0 0
215 Agus Kosasih, Tn 23602 31/07/2018 1/8/2018 1 1
0 0 0
216 Tiara Santika, Nn 25676 31/07/2018 1/8/2018 1 1
0 0 0
217 Agung Budiono, Sdr 25678 31/07/2018 2/8/2018 2 2
0 0 0
526 0 0 526 13
ah Sakit

Plebitis ISK Decubitus Kultur

1 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
1 0 0 0
0 0 0 0
1 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
1 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
1 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
5 0 0 0
 Formulir Pengumpulan Surveilans Infeksi Rumah Sakit

UNIT : ICU
Bulan/Tahun : Juli 2018

Jumlah hari pemakaian alat

No Nama Ps Register Tgl Masuk Tgl Keluar Lama dirawat
ETT CVL IVL UC
1 3
Nani Cuskemi, Ny 24405 6/30/2018 7/4/2018 3 0 0 3
2 5
Tarmiin, Tn 24433 7/1/2018 7/5/2018 5 0 0 5
3 1
Karwi, Ny 24393 7/3/2018 7/3/2018 1 0 0 1
4 1
Sarpah, Tn 24566 7/3/2018 7/4/2018 1 0 0 1
5 4
Wardinah, Tn 24574 7/4/2018 7/7/2018 4 0 0 4
6 3
Angwas, Tn 24618 7/4/2018 7/7/2018 3 0 0 3
7 1
Niken Ponco Laksmito Rini, Ny 4970 7/5/2018 7/5/2018 1 0 0 1
8 1
Sayudi Ratno, Tn 24669 7/6/2018 7/6/2018 1 0 0 1
9 2
Surjaya, Tn 24696 7/6/2018 7/8/2018 2 0 0 2
10 1
Masunah, Ny 24720 7/8/2018 7/8/2018 1 0 0 1
11 1
H. Nawawi,Tn 24726 7/8/2018 7/9/2018 1 0 0 1
12 3
Sarwi, Ny 24740 7/8/2018 7/11/2018 3 0 0 3
13 2
H. Nawawi,Tn 24726 7/9/2018 7/11/2018 2 0 0 2
14 1
Surtini, Ny 24848 7/10/2018 7/11/2018 1 0 0 1
15 1
Suta, Tn 24981 7/12/2018 7/12/2018 1 0 0 1
16 2
Sarah, Ny 25001 7/13/2018 7/14/2018 2 0 0 2
17 3
Sriyati, Ny 24998 7/13/2018 7/16/2018 3 0 0 3
18 1
Juminah, Ny 15081 7/14/2018 7/15/2018 1 0 0 1
19 2
Eko Budiharto, Tn 25032 7/14/2018 7/16/2018 2 0 0 2
20 1
Tarsinah, Ny 25055 7/15/2018 7/16/2018 1 0 0 1
21 2
Wahyudi, Tn 25056 7/15/2018 7/17/2018 2 0 0 2
22 4
Tarsinih,Tn 25064 7/16/2018 7/19/2018 4 0 0 4
23 3
A. Sumarsih, Ny 25113 7/16/2018 7/19/2018 3 0 0 3
24 0
Kristiani, Ny 10814 7/17/2018 7/17/2018 0 0 0 0
25 2
Margunah, Tn 25160 7/18/2018 7/19/2018 2 0 0 2
26 3
Rasba, Tn 25241 7/20/2018 7/22/2018 3 0 0 3
27 4
Eti Sugiarti, Ny 25132 7/21/2018 7/25/2018 4 0 0 4
28 3
Antiman, Tn 25309 7/21/2018 7/24/2018 3 0 0 3
29 1
H. Taryana,Tn 19775 7/23/2018 7/24/2018 1 0 0 1
30 3
Karsih,Ny 25098 7/24/2018 7/27/2018 3 0 0 3
31 1
Carimpen,Ny 25486 7/25/2018 7/26/2018 1 0 0 1
32 1
Wasem,Ny 25390 7/25/2018 7/27/2018 1 0 0 1
33 2
Sutinih, Ny 17012 7/30/2018 7/31/2018 2 0 0 2
34 2 2 2
Tolib,Tn 25550 7/30/2018 8/1/2018 0 0
70 0 0 70 70
mah Sakit

Plebitis ISK Decubitus Kultur

0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
1 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
1 0 0 0
 Formulir Pengumpulan Surveilans Infeksi Rumah Sakit

UNIT : Arjuna Bedah

Bulan/Tahun : Juli 2018

Jumlah hari pemakaian alat

No Nama Ps Register Tgl Masuk Tgl Keluar Lama dirawat
ETT CVL IVL
1 Nurul agustin, Nn 24437 7/1/2018 7/2/2018 1 0 0 1
2 Linda R Siregar, Ny 24481 7/2/2018 7/4/2018 2 0 0 2
3 Aat Aryanto, Tn 24483 7/2/2018 7/3/2018 1 0 0 1
4 Dewi Mayang Saputri, Nn 21845 7/2/2018 7/3/2018 1 0 0 1
5 Taryono, Tn 24494 7/2/2018 7/4/2018 2 0 0 2
6 Agung Kurniawan, Sdr 24497 7/2/2018 7/4/2018 2 0 0 2
7 Rafa Zidny Ilyas, An 22687 7/2/2018 7/3/2018 1 0 0 1
8 Jumiatin,Ny 24468 7/2/2018 7/3/2018 1 0 0 1
9 Sunerih, Ny 24469 7/2/2018 7/4/2018 2 0 0 2
10 Kiki Agnessilova, Ny 24512 7/2/2018 7/3/2018 1 0 0 1
11 Sutini,Ny 24528 7/3/2018 7/4/2018 2 0 0 2
12 Andreanto, Sdr 24537 7/3/2018 7/5/2018 2 0 0 2
13 Basari, Tn 24559 7/3/2018 7/5/2018 2 0 0 2
14 Entris Sutrisno,Tn 24572 7/4/2018 7/6/2018 2 0 0 2
15 Suwandi, An 24604 7/4/2018 7/5/2018 1 0 0 1
16 Taspan, Tn 24613 7/4/2018 7/4/2018 1 0 0 1
17 Kosim,Tn 24606 7/4/2018 7/6/2018 2 0 0 2
18 Hamzah Luthfiansyah, An 24607 7/4/2018 7/5/2018 1 0 0 1
19 Sukardi, Tn 23574 7/5/2018 7/7/2018 2 0 0 2
20 Naufal Thoriq Akbar, An 24648 7/5/2018 7/6/2018 1 0 0 1
21 Kristiani, Ny 10814 7/5/2018 7/12/2018 7 0 0 7
22 Nirma Budiarti Ningsih,Ny 24682 7/7/2018 7/8/2018 1 0 0 1
23 Sardika, Tn 21373 7/7/2018 7/8/2018 2 0 0 2
24 H. Nawawi,Tn 24726 7/8/2018 7/8/2018 1 0 0 1
25 Uwon Darsono, Tn 24755 7/9/2018 7/11/2018 2 0 0 2
26 Ijeh, Ny 24761 7/9/2018 7/10/2018 1 0 0 1
27 Masini, Ny 23264 7/9/2018 7/10/2018 1 0 0 1
28 Tri Yunita, Nn 24797 7/9/2018 7/18/2018 9 0 0 9
29 Jumiatin,Ny 24468 7/10/2018 7/12/2018 2 0 0 2
30 Hema Malini, Ny 24819 7/10/2018 7/11/2018 1 0 0 1
31 Nurhayati,Ny 24870 7/11/2018 7/12/2018 2 0 0 2
32 Daming,Tn 24896 7/11/2018 7/13/2018 2 0 0 2
33 Rina, Ny 24943 7/12/2018 7/14/2018 3 0 0 3
34 Kaidi, Tn 24991 7/12/2018 7/13/2018 1 0 0 1
35 Dany Hendriana, Tn 25005 7/13/2018 7/14/2018 1 0 0 1
36 Karni, Ny 25004 7/13/2018 7/15/2018 2 0 0 2
37 Sayidi, Tn 25014 7/13/2018 7/14/2018 1 0 0 1
38 Sunengsih,Ny 25020 7/13/2018 7/14/2018 1 0 0 1
39 Sarmita,Tn 24753 7/13/2018 7/14/2018 1 0 0 1
40 Rama Nurdiansyah, Tn 25023 7/14/2018 7/14/2018 1 0 0 1
41 Rita Haryati, Ny 24947 7/14/2018 7/15/2018 2 0 0 2
42 Kristiani, Ny 10814 7/15/2018 7/17/2018 2 0 0 2
43 Titin Suhaerah, Ny 24243 7/16/2018 7/19/2018 3 0 0 3
44 Navilah Laillyah,Ny 25136 7/17/2018 7/18/2018 1 0 0 1
45 Toib, Tn 25127 7/17/2018 7/19/2018 2 0 0 2
46 Eti Sugiarti, Ny 25132 7/17/2018 7/19/2018 2 0 0 2
47 Suyanto, Tn 25133 7/17/2018 7/19/2018 2 0 0 2
48 Iis Nuroniah, Ny 20862 7/17/2018 7/19/2018 2 0 0 2
49 Arif Wahyudin,Sdr 25153 7/17/2018 7/19/2018 2 0 0 2
50 Arif Ujianto,Tn 25180 7/18/2018 7/19/2018 2 0 0 2
51 Mokhamad Makhfuddin,Tn 24586 7/18/2018 7/19/2018 2 0 0 2
52 Sarah, Ny 25190 7/18/2018 7/21/2018 4 0 0 4
53 Naufal Thoriq Akbar, An 24648 7/18/2018 7/18/2018 1 0 0 1
54 Arinie Falhah,Nn 25221 7/19/2018 7/20/2018 1 0 0 1
55 Rasba, Tn 25241 7/19/2018 7/20/2018 1 0 0 1
56 Unsiyah, Ny 25188 7/19/2018 7/20/2018 1 0 0 1
57 Nuradi,Tn 25238 7/19/2018 7/21/2018 2 0 0 2
58 Darki, Tn 25253 7/19/2018 7/21/2018 2 0 0 2
59 Cartisem, Ny 25262 7/20/2018 7/21/2018 2 0 0 2
60 Sujani,Tn 25273 7/20/2018 7/21/2018 1 0 0 1
61 Iis Nuroniah, Ny 20862 7/20/2018 7/23/2018 3 0 0 3
62 Sulaeman,Tn 25277 7/20/2018 7/21/2018 1 0 0 1
63 Eti Sugiarti, Ny 25132 7/21/2018 7/21/2018 1 0 0 1
64 Darmun, Tn 25310 7/21/2018 7/22/2018 1 0 0 1
65 Lislianti, Nn 25360 7/23/2018 7/24/2018 1 0 0 1
66 Wardi Alextif A Tn 7248 7/23/2018 7/24/2018 1 0 0 1
67 Tarmun,Tn 24849 7/23/2018 7/24/2018 1 0 0 1
68 Ratinah, Ny 22051 7/23/2018 7/25/2018 2 0 0 2
69 Kaminah,Ny 25405 7/24/2018 7/28/2018 4 0 0 4
70 Nurul Faddilah,Nn 25502 7/26/2018 7/27/2018 1 0 0 1
71 Herri Rohyadi,Tn 23306 7/26/2018 7/27/2018 1 0 0 1
72 Warkim,Tn 25540 7/27/2018 7/28/2018 1 0 0 1
73 Nauval Ananta Hidayatullah, Sdr 25577 7/28/2018 7/31/2018 3 0 0 3
74 Saminah,Ny 25616 7/30/2018 7/31/2018 1 0 0 1
75 Duniyati, Ny 19920 7/30/2018 7/31/2018 1 0 0 1
76 Bilqis Sugiarti, Ny 25621 7/30/2018 7/31/2018 1 0 0 1
77 Ade Sholiha, Ny 25618 7/30/2018 7/31/2018 1 0 0 1
78 Markus Hadinata, Tn 25544 7/31/2018 8/1/2018 1 0 0 1
79 Ratini,Ny 25655 7/31/2018 8/2/2018 2 0 0 2
80 Ramidi, Tn 25677 7/31/2018 8/1/2018 1 0 0 1
138 0 0 138
mah Sakit

pemakaian alat
Plebitis ISK Decubitus Kultur
UC
0 0 0 0 0
1 0 0 0 0
1 0 0 0 0
0 0 0 0 0
1 0 0 0 0
1 0 0 0 0
1 0 0 0 0
0 0 0 0 0
1 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
1 0 0 0 0
0 0 0 0 0
1 0 0 0 0
0 0 0 0 0
2 1 0 0 0
0 0 0 0 0
0 0 0 0 0
1 0 0 0 0
1 0 0 0 0
0 0 0 0 0
1 0 0 0 0
2 1 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
1 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
1 0 0 0 0
0 0 0 0 0
0 0 0 0 0
1 0 0 0 0
0 0 0 0 0
1 0 0 0 0
0 0 0 0 0
1 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 1 0 0 0
0 0 0 0 0
0 0 0 0 0
1 0 0 0 0
0 0 0 0 0
1 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 1 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
1 0 0 0 0
23 4 0 0 0
 Formulir Pengumpulan Surveilans Infeksi Rumah Sakit

UNIT : Eksekutif
Bulan/Tahun : Juli 2018

Jumlah hari pemakaian alat

No Nama Ps Register Tgl Masuk Tgl Keluar Lama dirawat
ETT CVL IVL
1 Masduki,Tn 11969 29-06-2018 3/7/2018 2 2
0 0
2 Rysakha Azmi Yunanto, An 20428 30-06-2018 2/7/2018 1 1
0 0
3 Warjan Suharja, Tn 24554 3/7/2018 5/7/2018 2 2
0 0
4 Dursono, Tn 8487 3/7/2018 8/7/2018 5 5
0 0
5 Noviana, Ny 24605 4/7/2018 4/7/2018 1 1
0 0
6 Marsya Jenica Salsabila, An 24627 5/7/2018 6/7/2018 1 1
0 0
7 Aulia Nuha. A, Nn 19325 5/7/2018 7/7/2018 2 2
0 0
8 Agnes Santi Anggraeni, Ny 19472 6/7/2018 6/7/2018 1 1
0 0
9 Dipen, Ny 24072 6/7/2018 8/7/2018 2 2
0 0
10 Khaerudin, Tn 8745 6/7/2018 9/7/2018 3 3
0 0
11 Mahmud, Tn 24723 7/7/2018 10/7/2018 3 3
0 0
12 Hj. Warkinah, Ny 3574 8/7/2018 10/7/2018 2 2
0 0
13 Desy Rahmawati Syah, Ny 24736 8/7/2018 10/7/2018 2 2
0 0
14 Kamun, Tn 24778 9/7/2018 11/7/2018 2 2
0 0
15 Hj. Iin Inanah, Ny 24775 9/7/2018 13-07-2018 4 4
0 0
16 Darlem, Ny 24829 10/7/2018 13-07-2018 3 3
0 0
17 Nyai Susilawati, Ny 21245 10/7/2018 12/7/2018 2 2
0 0
18 Carmi, Ny 24839 10/7/2018 11/7/2018 2 2
0 0
19 Ramadhanissa Gizka, An 24858 11/7/2018 12/7/2018 1 1
0 0
20 Diana Fitrianingsih, Ny 24895 11/7/2018 12/7/2018 1 1
0 0
21 Nurmi, Ny 24967 12/7/2018 14-07-2018 2 2
0 0
22 H. Mundakir 24987 12/7/2018 17-07-2018 5 5
0 0
23 Waskunah, Ny 3454 12/7/2018 16-07-2018 4 4
0 0
24 Dimas Pambagiya,Sdr 24988 12/7/2018 14-07-2018 2 2
0 0
25 Tampen, Ny 22327 12/7/2018 16-07-2018 4 4
0 0
26 Hj. Robiatin, Ny 25019 13-07-2018 16-07-2018 3 3
0 0
27 Rama Nurdiansyah, Tn 25023 14-07-2018 14-07-2018 1 1
0 0
28 Dipen, Ny 24072 14-07-2018 16-07-2018 2 2
0 0
29 Alula Barrah Nazafarin , An 12204 15-07-2018 17-07-2018 2 2
0 0
30 Sri Sugiyanti, Ny 25057 16-07-2018 18-07-2018 2 2
0 0
31 H. Dr. Mohammad Toha, Tn 1463 16-07-2018 18-07-2018 2 2
0 0
32 Sunarto, Tn 25118 17-07-2018 19-07-2018 2 2
0 0
33 Mirza Virendra Arshaka, An 25150 17-07-2018 19-07-2018 2 2
0 0
34 Nael Zuhda Ahmada, An 2685 17-07-2018 19-07-2018 2 2
0 0
35 Salem, Ny 12261 18-07-2018 19-07-2018 1 1
0 0
36 Hj. Wasni, Ny 832 18-07-2018 21-07-2018 3 3
0 0
37 Nanang Supyandi, Tn 25209 20-07-2018 22-07-2018 2 2
0 0
38 Anisa, Ny 25267 20-07-2018 21-07-2018 1 1
0 0
39 Maryono,Tn 25279 20-07-2018 22-07-2018 2 2
0 0
40 Kastiri,Ny 25305 21-07-2018 23-07-2018 2 2
0 0
41 Caskiwan, Tn 25311 22-07-2018 22-07-2018 1 0 0 1
42 Casmirah, Ny 20000 22-07-2018 25-07-2018 3 3
0 0
43 Alula Barrah Nazafarin , An 12204 22-07-2018 24-07-2018 2 2
0 0
44 Fiya Annisa Indriyani Nn 7 25-07-2018 28-07-2018 3 3
0 0
45 Edi Syahputra,Tn 25485 25-07-2018 27-07-2018 2 2
0 0
46 Karinih BT Kawi, Ny 25509 26-07-2018 30-07-2018 4 4
0 0
47 Kian Farozat, An 25551 27-07-2018 30-07-2018 3 3
0 0
48 Hj. Taspen 25574 28-07-2018 29-07-2018 1 1
0 0
49 Siti Maulidathul H,Nn 25585 29-07-2018 31-07-2018 2 2
0 0
50 H. Rawun, Tn 25591 29-07-2018 2/8/2018 3 3
0 0
51 Undang Sutarna,Tn 25586 29-07-2018 4/8/2018 3 3
0 0
52 Carkilan, Tn 16302 31-07-2018 2/8/2018 1 1
0 0
53 Izah, Ny 21733 31-07-2018 1/8/2018 1 0 0 1
117 0 0 117
117 117
ksi Rumah Sakit

i pemakaian alat
Plebitis ISK Decubitus Kultur Keterangan
UC

0 0 0 0 0 Eksekutif
0 0 0 0 0 Eksekutif
0 0 0 0 0 Eksekutif
0 1 0 0 0 Eksekutif
0 0 0 0 0 Eksekutif
0 0 0 0 0 Eksekutif
0 0 0 0 0 Eksekutif
0 0 0 0 0 Eksekutif
0 0 0 0 0 Eksekutif
0 0 0 0 0 Eksekutif
0 0 0 0 0 Eksekutif
0 0 0 0 0 Eksekutif
0 0 0 0 0 Eksekutif
0 0 0 0 0 Eksekutif
0 0 0 0 0 Eksekutif
0 0 0 0 0 Eksekutif
0 0 0 0 0 Eksekutif
0 0 0 0 0 Eksekutif
0 0 0 0 0 Eksekutif
0 0 0 0 0 Eksekutif
0 0 0 0 0 Eksekutif
0 1 0 0 0 Eksekutif
0 0 0 0 0 Eksekutif
0 0 0 0 0 Eksekutif
0 0 0 0 0 Eksekutif
0 0 0 0 0 Eksekutif
0 0 0 0 0 Eksekutif
2 0 0 0 0 Eksekutif
0 0 0 0 0 Eksekutif
0 0 0 0 0 Eksekutif
0 0 0 0 0 Eksekutif
0 0 0 0 0 Eksekutif
0 0 0 0 0 Eksekutif
0 0 0 0 0 Eksekutif
0 0 0 0 0 Eksekutif
0 0 0 0 0 Eksekutif
0 0 0 0 0 Eksekutif
0 0 0 0 0 Eksekutif
0 0 0 0 0 Eksekutif
0 0 0 0 0 Eksekutif
0 0 0 0 0 Eksekutif
0 0 0 0 0 Eksekutif
0 0 0 0 0 Eksekutif
0 0 0 0 0 Eksekutif
0 0 0 0 0 Eksekutif
0 0 0 0 0 Eksekutif
0 0 0 0 0 Eksekutif
0 0 0 0 0 Eksekutif
0 0 0 0 0 Eksekutif
0 0 0 0 0 Eksekutif
0 0 0 0 0 Eksekutif
0 0 0 0 0 Eksekutif
0 0 0 0 0 Eksekutif
2 2 0 0 0
 Formulir Pengumpulan Surveilans Infeksi Rumah Sakit

UNIT : Kebidanan & VK

Bulan/Tahun : Juli 2018

Jumlah hari pemakaian alat

No Nama Ps Register Tgl Masuk Tgl Keluar Lama dirawat
ETT CVL IVL
1 Warsiti, Ny 24432 7/2/2018 7/3/2018 1 1
0 0
2 Noviana, Ny 24605 7/4/2018 7/5/2018 1 1
0 0
3 Nur Khasanah, Ny 21508 7/2/2018 7/3/2018 1 1
0 0
4 Samsiyah, Ny 24424 7/1/2018 7/1/2018 1 1
0 0
5 Dewi Rukmanah, Ny 24735 7/8/2018 7/8/2018 1 1
0 0
6 Diah Wibawantika,Ny 20316 7/2/2018 7/4/2018 2 2
0 0
7 Novi Rahmawati, Ny 7595 7/1/2018 7/4/2018 3 3
0 0
8 Sunarni, Ny 24851 7/10/2018 7/11/2018 1 1
0 0
9 Muksonah, Ny 24556 7/3/2018 7/5/2018 2 2
0 0
10 Ratna Sari, Ny 17959 7/2/2018 7/2/2018 1 1
0 0
11 Tuti Ruminih, Ny 24860 7/11/2018 7/13/2018 2 2
0 0
12 Iis Sugiarti, Ny 21594 7/3/2018 7/5/2018 2 2
0 0
13 Jueni, Ny 24448 7/2/2018 7/3/2018 1 1
0 0
14 Devi Nur Vindisari, Ny 25082 7/16/2018 7/17/2018 1 1
0 0
15 Dessy Ratna Sondarih, Ny 24762 7/9/2018 7/10/2018 1 1
0 0
16 Carinih,Ny 24450 7/2/2018 7/3/2018 1 1
0 0
17 Ika Farida Kurniawati, Ny 25205 7/19/2018 7/20/2018 1 1
0 0
18 Fitri HIdayah, Ny 24776 7/9/2018 7/11/2018 2 2
0 0
19 Ayu Pramawati, Ny 23998 7/2/2018 7/3/2018 1 1
0 0
20 Siti Muniroh, Ny 25239 7/19/2018 7/21/2018 2 2
0 0
21 Dasirih, Ny 24784 7/9/2018 7/11/2018 2 2
0 0
22 Nur Khodijah, Ny 24458 7/2/2018 7/3/2018 1 1
0 0
23 Monik Ariyanti, Ny 25295 7/21/2018 7/22/2018 1 1
0 0
24 Sri Iip Pitria sari, Ny 24825 7/10/2018 7/10/2018 1 1
0 0
25 Waryi, Ny 24454 7/2/2018 7/3/2018 1 1
0 0
26 Uul Ukiyah 25342 7/23/2018 7/23/2018 1 1
0 0
27 Uun Kurnaesih, Ny 24850 7/11/2018 7/12/2018 1 1
0 0
28 Kartiyem, Ny 24146 7/2/2018 7/11/2018 9 9
0 0
29 Yanti Waryuni, Ny 25440 7/25/2018 7/26/2018 1 1
0 0
30 Toeni Bt cadap, Ny 24909 7/11/2018 7/13/2018 2 2
0 0
31 Handayani Isma. J, Ny 16654 7/3/2018 7/3/2018 1 1
0 0
32 Reni Septianingsih,Ny 25554 7/27/2018 7/29/2018 2 2
0 0
33 Juwetin, Ny 24958 7/12/2018 7/14/2018 2 2
0 0
34 Sulastri, Ny 23876 7/3/2018 7/5/2018 2 2
0 0
35 Eka Indriyani, Ny 24969 7/12/2018 7/13/2018 1 1
0 0
36 Alien Pratiwi, Ny 24560 7/3/2018 7/4/2018 1 1
0 0
37 Nur Anisa Ny 3738 7/12/2018 7/14/2018 2 2
0 0
38 Ratna Sari, Ny 24569 7/4/2018 7/6/2018 2 2
0 0
39 Samsiah anggraeni, NY 24989 7/12/2018 7/14/2018 2 2
0 0
40 Kartinah BT Rawin,Ny 24576 7/4/2018 7/5/2018 1 1
0 0
41 Sriyati, Ny 24998 7/13/2018 7/13/2018 1 1
0 0
42 Roheti, Ny 24621 7/4/2018 7/6/2018 2 2
0 0
43 Fitri Eti,Ny 24937 7/13/2018 7/15/2018 2 2
0 0
44 Dian Sugianti, Ny 24632 7/5/2018 7/6/2018 1 1
0 0
45 Evi Triani, Ny 25007 7/13/2018 7/15/2018 2 2
0 0
46 Nunirih, Ny 24664 7/5/2018 7/6/2018 1 1
0 0
47 Tri Santi,Ny 25042 7/15/2018 7/16/2018 1 1
0 0
48 Marsini, Ny 22853 7/6/2018 7/6/2018 1 1
0 0
49 Qory Nurlinah E, Ny 25052 7/15/2018 7/18/2018 3 3
0 0
50 Iip Khonifa, Ny 17612 7/6/2018 7/7/2018 1 1
0 0
51 FEBRIYANTI DIAN PUSPITASARI, Ny 22088 7/16/2018 7/18/2018 2 2
0 0
52 Rina Kusumawati, Ny 22462 7/6/2018 7/8/2018 2 2
0 0
53 Linda Diana, Ny 24950 7/17/2018 7/19/2018 2 2
0 0
54 Agnes Santi Anggraeni, Ny 19472 7/6/2018 7/8/2018 2 2
0 0
55 Soleha, Ny 25161 7/18/2018 7/20/2018 2 2
0 0
56 Tri Budiyanti, Ny 24690 7/6/2018 7/8/2018 2 2
0 0
57 Warsinah,Ny 25215 7/19/2018 7/21/2018 2 2
0 0
58 Ika Nuryani,Ny 23515 7/7/2018 7/9/2018 2 2
0 0
59 Siti Rokhmah, Ny 13657 7/19/2018 7/22/2018 3 3
0 0
60 Faryatin, Ny. 24152 7/7/2018 7/7/2018 1 1
0 0
61 Nia Romadon, Ny 25290 7/21/2018 7/22/2018 1 1
0 0
62 Desi Siti Lestasri, Ny 24707 7/7/2018 7/9/2018 2 2
0 0
63 Khodriyah, Ny 25507 7/26/2018 7/28/2018 2 2
0 0
64 Masanah,Ny 24749 7/9/2018 7/10/2018 1 1
0 0
65 Indriyani,Ny 25531 7/27/2018 7/29/2018 2 2
0 0
66 Kadmi BT Raspan,Ny 24577 7/11/2018 7/12/2018 1 1
0 0
67 Wartinih, Ny 25539 7/27/2018 7/28/2018 1 1
0 0
68 Muniri, Ny 24905 7/11/2018 7/12/2018 1 1
0 0
69 Widiana,Ny 25546 7/27/2018 7/27/2018 1 1
0 0
70 Siti Maryam Fitri, Ny 24867 7/11/2018 7/12/2018 1 1
0 0
71 Annas Nuraeni, Ny 25569 7/28/2018 7/29/2018 1 1
0 0
72 silfiana, Ny 23008 7/11/2018 7/13/2018 2 2
0 0
73 Leni Fitriani, Ny 25568 7/28/2018 7/30/2018 2 2
0 0
74 Meiliani Ismaya, Ny 19064 7/13/2018 7/14/2018 1 1
0 0
75 Putri Aenun, Ny 25578 7/28/2018 7/30/2018 2 2
0 0
76 Krishna Harnum, Ny 25015 7/13/2018 7/14/2018 1 1
0 0
77 Masika, Ny 25583 7/29/2018 7/30/2018 1 1
0 0
78 Kantisah,Ny 23331 7/14/2018 7/16/2018 2 2
0 0
79 Ajeng Niarti Arfiani, Ny 18491 7/30/2018 7/31/2018 1 1
0 0
80 Astri Indriastuti, Ny 14105 7/15/2018 7/17/2018 2 2
0 0
81 Nurjanah Ny 6331 7/15/2018 7/18/2018 3 3
0 0
82 Tuslikhah, Ny 24713 7/16/2018 7/18/2018 2 2
0 0
83 Diana Sofiatin, Ny 25107 7/16/2018 7/17/2018 1 1
0 0
84 Selvy Ayu Fadila, Ny 25114 7/17/2018 7/19/2018 2 2
0 0
85 Raniti,Ny 25146 7/17/2018 7/20/2018 3 3
0 0
86 Windrawati, Ny 25156 7/17/2018 7/20/2018 3 3
0 0
87 Salimah, Ny 24285 7/18/2018 7/20/2018 2 2
0 0
88 Sri Wulan, Ny 25185 7/18/2018 7/20/2018 2 2
0 0
89 Dwi puspa ariyani 25191 7/18/2018 7/20/2018 2 2
0 0
90 Diana Epilaya, Ny 1317 7/18/2018 7/20/2018 2 2
0 0
91 Ika Putriana 24750 7/18/2018 7/20/2018 2 2
0 0
92 Rumini, Ny 20473 7/18/2018 7/19/2018 1 1
0 0
93 Sri Prihandini, Ny 25236 7/19/2018 7/19/2018 1 1
0 0
94 Yuliana Ny 4788 7/20/2018 7/21/2018 1 1
0 0
95 Furita Indrasari,Ny 25285 7/20/2018 7/22/2018 2 2
0 0
96 Nur Indah yani, Ny 25293 7/21/2018 7/23/2018 2 2
0 0
97 Nuraeni,Ny 25303 7/21/2018 7/22/2018 1 1
0 0
98 Titin Hartini, Ny 25318 7/22/2018 7/23/2018 1 1
0 0
99 Maria Ulfah, Ny 25319 7/22/2018 7/24/2018 2 2
0 0
100 Rizka Zakiyah, Ny 24532 7/22/2018 7/22/2018 1 1
0 0
101 Rosita,Ny 25341 7/23/2018 7/23/2018 1 1
0 0
102 Iin Wahyuni, Ny 25357 7/23/2018 7/24/2018 1 1
0 0
103 Nurbaeti,Ny 25210 7/23/2018 7/24/2018 1 1
0 0
104 Rizka Amalia, Ny 25373 7/23/2018 7/25/2018 2 2
0 0
105 Sunarsih, Ny 25376 7/23/2018 7/25/2018 2 2
0 0
106 Masanah,Ny 24749 7/23/2018 7/25/2018 2 2
0 0
107 Fifit Fitriyah, Ny 22854 7/24/2018 7/26/2018 2 2
0 0
108 Ambiyatun,Ny 25386 7/24/2018 7/24/2018 1 1
0 0
109 Rosidah Januarti, Ny 25445 7/25/2018 7/26/2018 1 1
0 0
110 Dariyah, Ny 11342 7/25/2018 7/26/2018 1 1
0 0
111 Sutirah, Ny 25462 7/25/2018 7/26/2018 1 1
0 0
112 Dede Feriza Amin, Ny 25469 7/25/2018 7/27/2018 2 2
0 0
113 Nur Aisiyah, Ny 24752 7/26/2018 7/27/2018 1 1
0 0
114 Susheri,Ny 23242 7/26/2018 7/26/2018 1 1
0 0
115 Ropika Sari, Ny 25575 7/28/2018 7/30/2018 2 2
0 0
116 Handayani Isma. J, Ny 16654 7/29/2018 7/30/2018 1 1
0 0
117 Sri Wahyuliyanti, Nn 21217 7/29/2018 7/30/2018 1 1
0 0
118 Fitriyah, Ny 25594 7/29/2018 7/30/2018 1 1
0 0
119 Intan Rahayu Kuswoharti, Ny 25614 7/30/2018 7/31/2018 1 1
0 0
120 Tati Widiasari,Ny 25601 7/30/2018 7/31/2018 1 1
0 0
189 0 0 189
ksi Rumah Sakit

ari pemakaian alat

Plebitis ISK Decubitus Kultur Keterangan
UC

0 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
1 0 0 0 0 Kebidanan
1 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
1 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
1 0 0 0 0 Kebidanan
1 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
1 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
1 0 0 0 0 Kebidanan
1 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
0 1 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
1 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
1 0 0 0 0 Kebidanan
1 0 0 0 0 Kebidanan
1 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
1 0 0 0 0 Kebidanan
1 0 0 0 0 Kebidanan
1 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
1 0 0 0 0 Kebidanan
1 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
1 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
1 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
1 0 0 0 0 Kebidanan
1 0 0 0 0 Kebidanan
1 0 0 0 0 Kebidanan
1 0 0 0 0 Kebidanan
1 0 0 0 0 Kebidanan
1 0 0 0 0 Kebidanan
1 0 0 0 0 Kebidanan
1 0 0 0 0 Kebidanan
1 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
1 0 0 0 0 Kebidanan
1 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
1 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
1 0 0 0 0 Kebidanan
1 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
1 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
1 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
1 0 0 0 0 Kebidanan
1 0 0 0 0 Kebidanan
1 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
1 0 0 0 0 Kebidanan
1 0 0 0 0 Kebidanan
1 0 0 0 0 Kebidanan
1 0 0 0 0 Kebidanan
1 0 0 0 0 Kebidanan
1 0 0 0 0 Kebidanan
1 0 0 0 0 Kebidanan
1 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
1 0 0 0 0 Kebidanan
1 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
1 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
1 0 0 0 0 Kebidanan
1 0 0 0 0 Kebidanan
1 0 0 0 0 Kebidanan
1 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
1 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
1 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
0 0 0 0 0 Kebidanan
55 1 0 0 0 0
 Formulir Pengumpulan Surveilans Infeksi Rumah S

UNIT : Peri dan Nicu

Bulan/Tahun : Juli 2018

Jumlah hari pemak

No Nama Ps Register Tgl Masuk Tgl Keluar Lama dirawat
ETT
1 By.ny Desy tri L 24429 7/30/2018 8/1/2018 2 0
2 By.ny Nur aliyah 24431 7/30/2018 8/1/2018 2 0
3 By. Ny. Samsiyah 24435 7/1/2018 7/1/2018 1 0
4 by.ny ratna sari 24446 7/2/2018 7/2/2018 1 0
5 by.ny novi rahmawati 24451 7/2/2018 7/6/2018 4 0
6 by ny atikha 24036 7/2/2018 7/4/2018 2 0
7 By. Ny. Uti Murtinih 23772 7/2/2018 7/4/2018 2 0
8 by.ny efi afiyanti 24196 7/2/2018 7/4/2018 2 0
9 by.ny diah wibawantika 24516 7/2/2018 7/4/2018 2 0
10 by.ny handayani isma .j 24519 7/3/2018 7/3/2018 1 0
11 by ny muksonah 24567 7/3/2018 7/5/2018 2 0
12 by ny iis sugiarti 24568 7/3/2018 7/5/2018 2 0
13 by ny alien pratiwi 24570 7/4/2018 7/4/2018 1 0
14 by ny sulastri 24608 7/4/2018 7/4/2018 1 0
15 by ny ratnasari 24609 7/4/2018 7/6/2018 2 0
16 by.ny roheti 24623 7/4/2018 7/5/2018 1 0
17 by.ny dian sugianti 24659 7/5/2018 7/6/2018 1 0
18 by ny nunirih 24671 7/6/2018 7/7/2018 1 0
19 by ny marsinih 24672 7/6/2018 7/6/2018 0 0
20 by.ny iip khonifa 24680 7/6/2018 7/7/2018 1 0
21 by ny tri budiyanti 24697 7/6/2018 7/10/2018 4 0
22 By. Ny. Agnes Santi Anggraeni 24695 7/6/2018 7/7/2018 1 0
23 by ny faryatin 24701 7/7/2018 7/7/2018 0 0
24 By. Ny. Ika Nuryani 24702 7/7/2018 7/9/2018 2 0
25 by.ny desi siti lestari 24721 7/7/2018 7/9/2018 2 0
26 by. ny dasirih 24799 7/9/2018 7/11/2018 2 0
27 By. Ny. Dessy Ratna Sondarih 24801 7/10/2018 7/10/2018 0 0
28 by.ny Fitri Hidayah 24840 7/10/2018 7/11/2018 1 0
29 by ny alien pratiwi 24570 7/11/2018 7/13/2018 2 0
30 by ny toeni bt cadap 24926 7/11/2018 7/13/2018 2 0
31 by.ny silfiana 24945 7/12/2018 7/13/2018 1 0
32 by ny faryatin 24701 7/12/2018 7/14/2018 2 0
33 by ny juwetin 24978 7/12/2018 7/14/2018 2 0
34 By Ny Samsiah Anggraeni, AMD. keb 24996 7/12/2018 7/14/2018 2 0
35 by.ny Sriyati 25000 7/13/2018 7/15/2018 2 0
36 by.ny.Fitri Eti 25016 7/13/2018 7/15/2018 2 0
37 by.ny.Evi triani 25017 7/13/2018 7/15/2018 2 0
38 by.ny.Meiliani Ismaya 25021 7/13/2018 7/14/2018 1 0
39 By Ny Krishna Harnum 25024 7/14/2018 7/14/2018 1 0
40 Rafif Danendra Heriansyah, An 25027 7/14/2018 7/14/2018 1 0
41 By N y Tri Santi 25044 7/15/2018 7/16/2018 1 0
42 by. ny kantisah 25045 7/15/2018 7/16/2018 1 0
43 By.ny nurjanah/muhammad haikal jamaludin An 25059 7/15/2018 7/18/2018 3 0
44 By.ny astri indriastuti 25058 7/15/2018 7/17/2018 2 0
45 By. Ny. Qory Nurlinah 25063 7/16/2018 7/18/2018 2 0
46 By. Ny. Ika Nuryani 24702 7/16/2018 7/18/2018 2 0
47 by.ny Devi Nur Vindisari 25099 7/16/2018 7/17/2018 1 0
48 Algi Alfarizi, By 25093 7/16/2018 7/19/2018 3 0
49 by.ny diana sofiatin 25109 7/16/2018 7/17/2018 1 0
50 by.ny selvy ayu fadila 25145 7/17/2018 7/19/2018 2 0
51 By. Ny. Lesa Yunita. L 25143 7/17/2018 7/19/2018 2 0
52 by.ny linda diana 25157 7/17/2018 7/19/2018 2 0
53 By Ny Raniti 25163 7/18/2018 7/20/2018 2 0
54 by.ny Soleha 25194 7/18/2018 7/20/2018 2 0
55 by.ny diana epilaya 25201 7/18/2018 7/20/2018 2 0
56 by.ny windrawati 25203 7/19/2018 7/20/2018 1 0
57 by ny rumini 25204 7/19/2018 7/19/2018 0 0
58 by ny ika putriana 25229 7/19/2018 7/20/2018 1 0
59 By Ny Warsinah 25244 7/19/2018 7/22/2018 4 0
60 by ny siti muniroh 25250 7/19/2018 7/21/2018 2 0
61 By Ny Ika Farida Kurniawati 25254 7/19/2018 7/20/2018 1 0
62 by.ny.Siti Rokhmah 25268 7/20/2018 7/22/2018 2 0
63 by.ny Yuliana 25274 7/20/2018 7/21/2018 1 0
64 by.ny nia romadon 25297 7/21/2018 7/22/2018 1 0
65 by.ny Monik ariyanti 25298 7/21/2018 7/22/2018 1 0
66 by ny nuraeni 25313 7/22/2018 7/22/2018 0 0
67 By.ny nur indah yani 25320 7/22/2018 7/23/2018 1 0
68 by.ny titin hartini 25325 7/22/2018 7/23/2018 1 0
69 by ny maria ulfah 25334 7/22/2018 7/25/2018 3 0
70 by ny rizka zakiyah 25338 7/23/2018 7/23/2018 0 0
71 by ny rosita 25343 7/23/2018 7/28/2018 5 0
72 by ny uul ukiyah 25363 7/23/2018 7/23/2018 0 0
73 BY.NY Iin Wahyuni 25371 7/23/2018 7/24/2018 1 0
74 by ny masanah 25382 7/23/2018 7/25/2018 2 0
75 by ny ambiyatun 25389 7/24/2018 7/24/2018 0 0
76 by.ny rizka amalia 25420 7/24/2018 7/25/2018 1 0
77 by.ny fifit fitriyah 25428 7/24/2018 7/26/2018 2 0
78 by.ny diana epilaya 25201 7/25/2018 7/27/2018 2 0
79 by.ny sutirah 25474 7/25/2018 7/26/2018 1 0
80 by.ny rosidah januarti 25484 7/25/2018 7/26/2018 1 0
81 by.ny dariyah 25483 7/25/2018 7/26/2018 1 0
82 by.ny dede feriza amien 25487 7/25/2018 7/27/2018 2 0
83 by.ny Nur Asiyah 25500 7/26/2018 7/28/2018 2 0
84 by ny rizka zakiyah 25338 7/26/2018 7/28/2018 2 0
85 by.ny Widiana 25548 7/27/2018 7/29/2018 2 0
86 by ny wartinih 25553 7/27/2018 7/28/2018 1 0
87 by ny indriyani 25555 7/27/2018 7/29/2018 2 0
88 by. ny reni septianingsih 25556 7/27/2018 7/29/2018 2 0
89 by.ny selvy ayu fadila 25145 7/28/2018 7/30/2018 2 0
90 By Ny Annas Nuraeni 25573 7/28/2018 7/29/2018 1 0
91 by. ny leni fitriani 25579 7/29/2018 7/30/2018 1 0
92 by.ny putri aenun 25580 7/29/2018 7/30/2018 1 0
93 by.ny ropika sari 25582 7/29/2018 7/31/2018 2 0
94 by ny masika 25593 7/29/2018 7/30/2018 2 0
95 by ny sri wahyuliyanti 25597 7/30/2018 7/30/2018 1 0
96 by ny fitriyah 25598 7/30/2018 7/30/2018 1 0
97 by ny ajeng niarti arfiani 25599 7/30/2018 7/31/2018 1 0
98 by ny intan rahayu kuswoharti 25634 7/31/2018 7/31/2018 1 0
99 by ny masanah 25382 7/31/2018 8/1/2018 1 0
100 By.ny Nida hanifatul hasna 25672 7/31/2018 8/1/2018 1 0
101 by.ny rizka amalia 25420 7/31/2018 8/1/2018 1 0
Total 155 0
s Infeksi Rumah Sakit

Jumlah hari pemakaian alat

Plebitis ISK Decubitus Kultur Keterangan
CVL IVL UC

0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 4 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 1 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 4 0 0 0 0 0
0 1 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 4 0 1 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 3 0 0 0 0 0
0 0 0 0 0 0 0
0 5 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 22 0 1 0 0 0 0
 Formulir Pengumpulan Surveilans Infeksi Rumah Sakit

UNIT : Bima
Bulan/Tahun : Juli 2018

Jumlah hari pemakaian alat

No Nama Ps Register Tgl Masuk Tgl Keluar Lama dirawat
ETT CVL IVL
1 Bima Putra, An 24518 3/7/2018 5/7/2018 2 2
0 0
2 Khanisa Putri Nadhira, An 24524 3/7/2018 5/7/2018 2 2
0 0
3 Nurul Fajriyah,An 24539 3/7/2018 6/7/2018 3 3
0 0
4 Wisnu, An 24563 3/7/2018 6/7/2018 3 3
0 0
5 Juna, An 24601 4/7/2018 5/7/2018 1 1
0 0
6 Adrian Diyastha Al-Yhandi, An 20027 5/7/2018 7/7/2018 2 2
0 0
7 Suci Khairunissa Rahmania Fatin, An 23586 6/7/2018 8/7/2018 2 2
0 0
8 Muhamad Topik, An 24681 6/7/2018 8/7/2018 2 2
0 0
9 Fayadh Al Gibran Junior, An 24683 6/7/2018 9/7/2018 3 3
0 0
10 Aurora Andes Rahayu, An 24684 6/7/2018 9/7/2018 3 3
0 0
11 By.Ny.Evi Puspita Dewi /Dimas Bayu S 13233 6/7/2018 9/7/2018 3 3
0 0
12 Avraham Dexter Pratama,An/ By NY CASITI 24699 7/7/2018 9/7/2018 2 2
0 0
13 Radja Akbar WD, An 24710 7/7/2018 9/7/2018 2 2
0 0
14 Rayza Dwi Kiano,An 16777 8/7/2018 11/7/2018 3 3
0 0
15 Resky Febry. K, An 2058 8/7/2018 11/7/2018 3 3
0 0
16 Caeril Fajar Alif Fatur. G, An 24731 8/7/2018 10/7/2018 2 2
0 0
17 Ridiaveka Naureen Almahyra, An 14720 8/7/2018 10/7/2018 2 2
0 0
18 Sandhi Yanuar Hakim, An 24739 8/7/2018 12/7/2018 4 4
0 0
19 AISYAH RIZKI INARA, An 24747 9/7/2018 10/7/2018 1 1
0 0
20 By. Ny. Tasih/Hisyam Al- ghazali, An 24757 9/7/2018 12/7/2018 3 3
0 0
21 Muhammad Deny, An 24790 9/7/2018 11/7/2018 2 2
0 0
22 Salman Arizki, An 24795 9/7/2018 07/13/2018 4 4
0 0
23 Nafla Adzkia Zahida, An 24779 9/7/2018 12/7/2018 3 3
0 0
24 Khanza Putri Nurazizah, An 24796 9/7/2018 11/7/2018 2 2
0 0
25 Lutfi Fakih R, An 24798 10/7/2018 11/7/2018 1 1
0 0
26 Salman,An 24822 10/7/2018 13-07-2018 3 3
0 0
27 Shelen Prisilia Oktaviani,An 24806 10/7/2018 12/7/2018 2 2
0 0
28 Rafardan rasyad alvero, an 24841 10/7/2018 13-07-2018 3 3
0 0
29 Hafiz Teguh Firmansyah, An 17093 10/7/2018 12/7/2018 2 2
0 0
30 Mohammad Abidzar Al Ghifari, An 24916 11/7/2018 14-07-2018 3 3
0 0
31 Audya Safania Nuryana, An 24930 11/7/2018 14-07-2018 3 3
0 0
32 Mirza Ukail Zaahirulhaq, An 24966 12/7/2018 14-07-2018 2 2
0 0
33 Muhammad fathan AlKhalif, An 24970 12/7/2018 15-07-2018 3 3
0 0
34 by ny faryatin 24701 12/7/2018 12/7/2018 0 0
0 0
35 Adelia faranisa Azni, An 24995 12/7/2018 15-07-2018 3 3
0 0
36 Diyanti Binti Likin, An 24992 12/7/2018 16-07-2018 4 4
0 0
37 Shafa Nur Aqilla, An 25034 14-07-2018 17-07-2018 3 3
0 0
38 Steven, An 25038 14-07-2018 16-07-2018 2 2
0 0
39 Jie, An 25039 14-07-2018 16-07-2018 2 2
0 0
40 Kendi Setiabudi, An 21892 14-07-2018 18-07-2018 4 4
0 0
41 Kayla, An 25053 15-07-2018 16-07-2018 1 1
0 0
42 Arsyfanie Shakira, An 2518 16-07-2018 17-07-2018 1 1
0 0
43 Almeera Misha Azzahra, An 25022 16-07-2018 18-07-2018 2 2
0 0
44 Askana Sakhi, An 18406 17-07-2018 20-07-2018 3 3
0 0
45 Yun an, An 25087 17-07-2018 19-07-2018 2 2
0 0
46 Nael Zuhda Ahmada, An 2685 17-07-2018 17-07-2018 0 0
0 0
47 Annisa siti jannah, An 25195 18-07-2018 20-07-2018 2 2
0 0
48 Rezka Al Bani, An 25202 19-07-2018 21-07-2018 2 2
0 0
49 Baskoro Alfan Rafishqi, An 25227 19-07-2018 20-07-2018 1 1
0 0
50 Muhammad Irsyad,An 25235 19-07-2018 21-07-2018 2 2
0 0
51 Revalin Andini, An 25257 19-07-2018 21-07-2018 2 2
0 0
52 by ny nunik/ Nada Khaira Ramdhani, An 4383 20-07-2018 22-07-2018 2 2
0 0
53 Kevin Berlian Nata, An 25275 20-07-2018 21-07-2018 1 1
0 0
54 Nathan Riayanto,An 25284 20-07-2018 22-07-2018 2 2
0 0
55 Imam Awal ramadani,An 25287 20-07-2018 22-07-2018 2 2
0 0
56 Aisha Syifa Salwarysta, An 25291 21-07-2018 23-07-2018 2 2
0 0
57 Sayyid Dzatul Kahfi, An 25323 22-07-2018 24-07-2018 2 2
0 0
58 Asfa Muzaffar, An 25330 22-07-2018 25-07-2018 3 3
0 0
59 Ausfina Zahra Amelia, An 24767 23-07-2018 24-07-2018 1 1
0 0
60 Ilham Adi Pradana An 6617 23-07-2018 25-07-2018 2 2
0 0
61 Arjun Aditya Nugroho, An 25379 23-07-2018 25-07-2018 2 2
0 0
62 Amelia, An 19556 24-07-2018 26-07-2018 2 2
0 0
63 by ny tiffanny/ Abiet Yusuf Kurniawan, An 12598 24-07-2018 26-07-2018 2 2
0 0
64 Muhammad Rizqi Hidayat, An 25419 24-07-2018 24-07-2018 0 0
0 0
65 Kuni Khoirunnisa, An 25424 24-07-2018 27-07-2018 3 3
0 0
66 Verrel Akasyah Siro, An 25430 24-07-2018 26-07-2018 2 2
0 0
67 Bilqish merianto Dewi 25467 25-07-2018 28-07-2018 3 3
0 0
68 Roy Umar, An 10786 25-07-2018 26-07-2018 1 1
0 0
69 Dinda Eka Putri,An 23479 25-07-2018 27-07-2018 2 2
0 0
70 sofa, An 25489 26-07-2018 27-07-2018 1 1
0 0
71 Bayi Ny Nurjannah/Dzaky Azzumar, By 11332 26-07-2018 28-07-2018 2 2
0 0
72 Shelen Prisilia Oktaviani,An 24806 26-07-2018 27-07-2018 1 1
0 0
73 Nurlaela 25516 26-07-2018 27-07-2018 1 1
0 0
74 Quinsha Nur Ihlila Muardi, An 25522 26-07-2018 28-07-2018 2 2
0 0
75 Atsiilah Hauraa Lutmia, An 25527 26-07-2018 28-07-2018 2 2
0 0
76 Muhammad Suud Faturohman, An 25528 27-07-2018 28-07-2018 1 1
0 0
77 Zalfa Azkayra,An 25552 27-07-2018 28-07-2018 1 1
0 0
78 Astisa Nisrina Aulia, An 1170 27-07-2018 31-07-2018 4 4
0 0
79 Milka Nur Aisyah, An 25572 28-07-2018 29-07-2018 1 1
0 0
80 Alwi Nurfattah, An 1844 28-07-2018 31-07-2018 3 3
0 0
81 Nur Humaedah, An 21525 28-07-2018 30-07-2018 2 2
0 0
82 Diva Arini, An 22367 29-07-2018 3/8/2018 5 5
0 0
83 Rajendra Indramawan, An 7615 29-07-2018 1/8/2018 3 3
0 0
84 Raffi, An 25592 29-07-2018 30-07-2018 1 1
0 0
85 Muhammad Habiburrahman, Sdr 25571 30-07-2018 2/8/2018 3 3
0 0
86 Averil Passa Khadafi, An 25629 30-07-2018 1/8/2018 2 2
0 0
87 Gilang Gunawan Putra, An 12584 30-07-2018 3/8/2018 4 4
0 0
88 SHAKILA KHAIRINA AL KADRI,An 25631 30-07-2018 4/8/2018 5 5
0 0
89 Nadilaura Hadisufi, An 25630 30-07-2018 2/8/2018 3 3
0 0
90 Roy Umar, An 10786 30-07-2018 4/8/2018 5 5
0 0
91 BY ny. darwati / Saidina Mualim, An 10380 31-07-2018 3/8/2018 3 3
0 0
92 by.ny rizka amalia 25420 31-07-2018 31-07-2018 0 0
0 0
93 Naufal Sayyid Ahmad Fakhri Putra Sanjaya, An 25675 31-07-2018 4/8/2018 4 4
0 0
94 Iyas Ihtisaban Yunsorun, An 19969 31-07-2018 4/8/2018 4 4
0 0
95 Firza Azzalea Karen, An 25679 31-07-2018 5/8/2018 5 5
0 0
219 0 0 219
i Rumah Sakit

hari pemakaian alat

Plebitis ISK Decubitus Kultur Keterangan
UC

0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 1 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 1 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 1 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 1 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 1 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 0 0 0 0 Bima
0 1 0 0 0 Bima
0 1 0 0 0 Bima
0 7 0 0 0 0